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INTERMOUNTAIN PHARMACY #12
DSH270049 Intermountain Health St Vincent Regional Hospital
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Covered Entity Details
Entity Name
Intermountain Health St Vincent Regional Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270049
Entity Address
1233 N. 30th Street
Billings, MT 59101
Medicare Provider Number
270049
Participating Start Date
10/1/2012
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
INTERMOUNTAIN PHARMACY #12
Pharmacy Address
1233 N 30TH ST
STE W103
BILLINGS, MT 59101
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pam Palagi, VP of Finacial Services
(406) 723-2414
Contract Pharmacy Representative
SCL Health
Maria Erickson, Pharmacy Manager
(406) 237-8115
Signed By Date
7/13/2018
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